This trial supported the use of both concomitant and bismuth-containing quadruple therapies as substitute first-line therapy for H. pylori-infected individuals as per earlier guidelines, especially in areas with a high incidence of clarithromycin resistance.

This prospective single-center, randomized superiority controlled clinical focused on evaluating the efficacy of two protocols- doxycycline-based quadruple regimen and levofloxacin concomitant regimen as empirical first-line therapy for the treatment of Helicobacter pylori (H. pylori) infected patients.

Seventy-eight naïve patients infected with H. pylori were included, and these patients were stratified into two groups based on therapies given twice daily for 2 weeks:

• D-group: 39 patients who received bismuth subsalicylate 524 mg four times every day, doxycycline 100 mg, tinidazole 500 mg, and esomeprazole 20 mg
• L-group: 39 patients who received levofloxacin 500 mg every day, tinidazole 500 mg, amoxicillin 1000 mg, and esomeprazole 20 mg each

After eight weeks of therapy, a stool antigen test was used to confirm the H. pylori elimination.

The number of participants who completed the follow-up and were cured is shown in Table 1:

The eradication rates as per intention-to-treat and per-protocol analyses are shown in Table 2:

No serious adverse effects were reported.

Levofloxacin therapy did not show superiority to doxycycline quadruple therapy. However, future research can help to find out the ideal first-line therapy for H. pylori.